A 17-month-old boy was presented to his general practitioner after his daycare provider found a worm embedded in his stool during diapering. The stool was described as having a solid consistency, and the worm was found only partially exposed. The patient was not suffering any obvious gastrointestinal symptoms; however, due to the child's young age, this could not be clearly elucidated. He lived in a rural area of Louisiana and had no travel history or documented exposure to animals. The patient had spent a considerable amount of time playing outdoors, and he was described as having put foreign objects in his mouth regularly while in this environment. His past medical history was notable for recurrent reactive airway disease, and he was slightly undersized for his age, although this was thought to be due to his premature birth; his twin brother was similarly sized. The child had no other physical abnormalities or developmental delays documented. Since he did not have any clinical symptoms, a diagnosis was based exclusively on laboratory examination of the worm.
The worm, preserved in ethanol and formalin, was creamy white and measured approximately 8 cm in length; however, the posterior end lacked structural definition and may have been broken off. The body appeared to have ridges and/or folds that resembled segmentation. The width of the worm was 0.6 cm at the anterior end and 0.3 to 0.4 cm at the posterior end (Fig. 1A). The worm appeared to have a large, hollow buccal cavity opening; however, upon microscopic examination and resection, a retracted proboscis with multiple rows of hooks was observed within the opening (Fig. 1B and C). The alcohol submitted with the worm was centrifuged, and unusual ova were observed on a wet mount preparation (Fig. 1D). The ova were ovoid and had a thick brown textured shell that measured approximately 50 by 100 μm.
FIG 1.
Macroscopic and microscopic features of a worm recovered from the stool of a 17-month-old boy. (A) Macroscopic appearance of the worm, measuring approximately 8 cm long. (B) Magnification (×125) of the anterior end of the worm. (C) Digital magnification (image captured at ×125 magnification) of the resected anterior end. (D) Digital magnification (image captured at ×400 magnification) of a 50-μm by 100-μm ovoid ovum, with a thick, textured shell seen in a wet mount iodine preparation of the sample.
(For answer and discussion, see page 2747 in this issue [doi:10.1128/JCM.00486-13].)